Hepatitis B risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Sara Mehrsefat, M.D. [3]

Overview

Common risk factors in the development of HBV infection include sexual contact with infected individuals, sharing a household with a carrier, intravenous drug use, travel to endemic regions, perinatal transmission from infected mothers to infants, and certain occupations.

Risk Factors

Individuals who are at increased risk of hepatitis B infection include:[1][2]

  • Infants born to infected mothers
  • Young children in day-care or residential settings with other children in endemic areas
  • Sexual/household contacts of infected persons
  • Patients and employees in hemodialysis centers
  • Injection drug users sharing unsterilized needles
  • People sharing unsterilized medical or dental equipment
  • People providing or receiving acupuncture and/or tattooing with unsterilized medical devices
  • Persons living in regions or travelling to regions with endemic hepatitis B
    • Country of origin is the major risk factor for HBV infection (prevalence threshold of 2% or greater to define countries with high risk for HBV infection)
  • Sexually active heterosexuals
  • Lack of vaccination in infancy
  • Men who have sex with men
  • Hemophilia patients
  • Travel to areas where hepatitis B is common

Frequent and routine exposure to blood or serum is the common denominator of healthcare occupational exposure.[3]

Hepatitis B Reactivation

Hepatitis B virus presents in all patients with infection. Patients who are either HBsAg-positive or anti HBc-positive are at the risk of hepatitis B reactivation.

Patients are at risk for HBV reactivation in the following conditions:[4][5][6][7][8][9]

References

  1. World Health Organization. Department of Cummunicable Disease Surveillance and Response http://apps.who.int/iris/bitstream/10665/67746/1/WHO_CDS_CSR_LYO_2002.2_HEPATITIS_B.pdf
  2. US. Preventive Services Task Force. Screening for Hepatitis B infection. (2014) https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014?ds=1&s=hepatitis%20b Accessed on October 4th, 2016
  3. "Hepatitis B" (PDF). 
  4. Lee YH, Bae SC, Song GG (2013). "Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy.". Clin Exp Rheumatol. 31 (1): 118–21. PMID 23111095. 
  5. Kim PS, Ho GY, Prete PE, Furst DE (2012). "Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B.". Arthritis Care Res (Hoboken). 64 (8): 1265–8. PMID 22392695. doi:10.1002/acr.21654. 
  6. Sagnelli E, Manzillo G, Maio G, Pasquale G, Felaco FM, Filippini P; et al. (1980). "Serum levels of hepatitis B surface and core antigens during immunosuppressive treatment of HBsAg-positive chronic active hepatitis.". Lancet. 2 (8191): 395–7. PMID 6105519. 
  7. Nair PV, Tong MJ, Stevenson D, Roskamp D, Boone C (1985). "Effects of short-term, high-dose prednisone treatment of patients with HBsAg-positive chronic active hepatitis.". Liver. 5 (1): 8–12. PMID 3884951. 
  8. Europian Medicines Agency. reviews direct-acting antivirals for hepatitis C. (2016) http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Direct-acting_antivirals_for_hepatitis_C_20/Procedure_started/WC500203479.pdf
  9. U.S Food and Drug Adminestration. Drug Safety Communication: FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C http://www.fda.gov/downloads/Drugs/DrugSafety/UCM523499.pdf

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